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2019 HSR&D/QUERI National Conference Abstract

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4094 — Effect of the Affordable Care Act on Healthcare Utilization for Veterans with Spinal Cord Injuries and Disorders

Lead/Presenter: Rachael Martinez,  COIN - Hines
All Authors: Martinez RN (Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL), Smith BM (Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL), Hogan TP (Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA) French D (Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL) Gonzalez B (Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL) Osteen C (Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL) Stroupe KT (Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL)

Objectives:
Provisions of the Affordable Care Act (ACA) potentially increase insurance options for Veterans with disabilities. This study aims to determine how the ACA has impacted where Veterans with SCI/D receive their healthcare.

Methods:
Using a sample of 18,624 Veterans with SCI/D, impact of VA healthcare utilization pre- (2013/14) and post-ACA (2015/16) were examined with regionally nested multivariate negative binomial regression models. Outcomes identified in national VA databases included total number of VA admissions, and numbers of VA visits for SCI/D care, diagnostic care, primary care, specialty care, and mental health care.

Results:
Overall, the total number of VA admissions were 14% higher in the post-ACA period compared to the pre-ACA period (p < 0.001). The total number of VA visits to SCI/D clinics were 7% higher in the post-ACA period compared to the pre-ACA period (p < 0.01). Increased VA utilization was also seen in number of visits for diagnostic care (10%; p < 0.001), primary care (8%, p < 0.001), and specialty care (20%; p < 0.001) from pre- to post-ACA. The total number of VA mental health visits were 9% lower in the post-ACA period compared to the pre-ACA period (p < 0.01). Veterans with SCI/D who live less than 5 miles from their nearest VA facility received care at the VA more frequently than those who live over 40 miles from the VA (p < 0.001).

Implications:
Results indicated that Veterans with SCI/D sought care at the VA in larger numbers even after ACA came into effect, suggesting that the aging Veteran population with SCI/D continues to value the lifelong, comprehensive care provided at VA. However, results also showed that distance to nearest VA matters. Veterans with SCI/D who lived closer to VA facilities were more likely to seek VA care than those who lived in rural areas. The distance effect may partially explain the decrease in VA mental health care visits as the ACA may provide more options to Veterans who live far away from their nearest VA facility.

Impacts:
As transportation for Veterans with SCI/D is especially difficult, it is important for the VA to consider ways of increasing access for this vulnerable population, especially those who live great distances from VA facilities.